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Infection Control
“A bad cold wouldn’t be so annoying if it weren’t for
the advice of our friends.”
Kin Hubbard
Abbreviations
CDC – Centers for Disease Control
AIDS – Acquired Immunodeficiency
Virus
CBC – Complete Blood Count
C&S – Culture and Sensitivity
HIV – Human Immunodeficiency Virus
PEP – Post Exposure Protocol
Asepsis
Medical – includes all practices intended
to confine a specific microorganism to a
specific area, limiting number, growth &
transmission – clean vs. dirty
Surgical Asepsis – sterile technique –
practices to keep an area free from all
microorganisms
Types of Infection
Local
Systemic
Acute
Chronic
Nosocomial Infections
Infections that are associated with the
delivery of health care services in a health
care facility
Point of origin
1. Endogenous
2. Exogenous
3. Iatrogenic
Risks for Nosocomial Infection
Poor hand washing
Compromised host – surgery/illness
Improper procedure technique –
dressing, suctioning, catherization
Improper cleaning/maintenance of
invasive devices – foley catheter, IV line
Contamination of closed drainage
system – chest tubes
Chain of Infection
Etiologic Agent
Reservoir
Portal of Exit from Reservoir
Method of Transmission
Portal of Entry into Susceptible Host
Susceptible Host
Etiologic Agents
Bacteria
Resident
Viruses
Transient
Fungi
Parasites
Reservoir
Environmental
Human
Animal/Insect
Portal of Exit from Reservoir
Mouth, nose
Urinary tract
Wounds
Device insertion sites
Other orifices
Method of Transmission
Direct
Indirect
Vehicle-borne
Vector-borne
Airborne
Factors Increasing
Susceptibility to Infection
Age
Heredity
Level of stress
Nutritional status
Medications
Illness –
acute/chronic
Body Defenses Against
Infection
Anatomic & Physiologic Barriers
Inflammatory Response
Antibody-Mediated Defenses
Cell-Mediated Defenses
Inflammatory Response
Five Signs:
1.
2.
3.
4.
5.
Pain
Swelling
Redness
Heat
Impaired Function
Three Stages:
1. Vascular and cellular
responses
2. Exudate production
3. Reparative phase
Antibody-Mediated Defenses
Active
Infectious microorganisms
Vaccines
Passive (Acquired)
Natural – breast milk
Artificial – immune serum
Cell-Mediated Defenses
T-cell system – exposure to antigen
causes release into lymph system
1. Helper
2. Cytotoxic
3. Suppressor
Course of Infection
Incubation period – time between initial
contact and appearance of symptoms
Prodromal stage – time from onset of
nonspecific symptoms to more specific
symptoms – transmission possible
Course of Infection
Full/Illness stage – time that specific
symptoms present – acute – transmission
possible
Convalescence – time when symptoms
resolve and host returns to pre-illness state
Laboratory Tests
White blood cell count – Leukocyte –
nonspecific unless differential done to break
down types of WBC’s – normal 4,500 –
11,000
2. Erythrocyte sedimentation rate – ESR –
increased rate of RBC’s settling in presence
of inflammatory process
3. Culture & Sensitivity – C&S urine, blood,
sputum, wound – determines organism and
effective medication
1.
Nursing Diagnosis
Risk for Infection – PRIMARY
Potential Complications of Infection
Impaired Physical Mobility
Imbalanced Nutrition
Acute Pain
Impaired Social Interaction/Social Isolation
Situational Low Self-Esteem
Anxiety
Breaking the Chain of
Infection
Host
Reservoir
Portal of Exit
Transmission
Portal of Entry
Interventions to Reduce Risk
of Infection
Preventing Nosocomial Infections:
1. Hand washing
2. Proper technique
3. Environmental controls
4. Management of clients at risk
Interventions to Reduce Risk
of Infection
Supporting Defenses of Susceptible
Host:
1. Hygiene
2. Nutrition
3. Fluid
4. Rest and sleep
5. Immunizations
6. Stress
Interventions to Reduce Risk
of Infection
Cleaning, Disinfecting, Sterilizing
Cleaning inhibits growth of microorganisms
Disinfecting with chemicals – bacteriostatic
vs. bactericidial
3. Sterilizing – destroys all microorganisms –
including spores/viruses – moist heat, gas,
boiling water, radiation
1.
2.
CDC Isolation Guidelines
Tier One
Standard Precautions
Tier Two –
Transmission Based
Precautions
Airborne
Droplet
Contact
Standard Precautions
All clients
Apply blood, body fluids,
excretions/secretions, non-intact skin,
mucous membranes
Designed to reduce risk of transmission
from all sources
Airborne Precautions
Infections spread through air – TB,
varicella, rubeola
Private room – negative air pressure/air
exchange
Door closed
Respiratory equipment
Mask client in transport
Droplet Precautions
Large particle droplet infections –
rubella, mumps, scarlet fever, some
pneumonias
Private room or cohort
Respiratory protective equipment –
within 3 feet of client
Transport client with mask
Contact Precautions
Infections spread by direct/indirect contact –
wound infections, scabies, antibiotic resistant
infections – MRSA, VRE
Private room or cohort
Gloves entering room – wash hands in room
Personal protective equipment when in direct
contact with infected body secretions
Limit movement client outside of room
Protective Isolation
Protects clients with compromised
immune systems
Private room
Protective garb worn in room – gloves,
gown, mask – may vary with facility
No fresh fruits, vegetables, flowers
Client mask outside of room
Guidelines for Exposure to
Bloodborne Pathogens
Report – verbal, written
Seek appropriate evaluation and followup
Puncture/laceration
Mucous membrane exposure
Post exposure protocols – PEP – HIV
and hepatitis B & C